Evaluation of thyromental height as a predictor of difficult laryngoscopy and difficult intubation: a cross-sectional observational study

Prakash, Smita; Mullick, Parul; Singh, Rajvir

doi:10.1016/j.bjane.2021.07.001

Cited by 3 publications

(10 citation statements)

References 21 publications

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Section: Resultsmentioning

confidence: 99%

“…As for the TMH measurement during preoperative assessment, 17 studies mentioned the use of either digital gauges (10 articles) [ 11 , 12 , 13 , 16 , 18 , 20 , 22 , 25 , 26 , 27 ] or regular rulers (7 articles) [ 14 , 15 , 17 , 19 , 23 , 24 , 33 ], while 6 studies failed to specify their measurement tools. Patients were placed in sniffing position for direct laryngoscopy and intubation in 14 studies [ 11 , 12 , 14 , 16 , 17 , 18 , 19 , 20 , 23 , 26 , 27 , 33 , 34 , 35 ]. During the direct laryngoscopy, a Macintosh blade was used in 17 studies in which one [ 31 ] used only size 3, 7 [ 12 , 16 , 17 , 18 , 20 , 23 , 26 ] used size 3 or 4, 2 [ 11 , 25 ] used only size 4, and 1 [ 13 ] used size 4 or 5.…”

Section: Resultsmentioning

confidence: 99%

“…As displayed in Figure 2 for methodological quality assessment by the QUADAS-2 tool, risk of bias in individual studies mainly came from patient selection, index test, and reference standard. Inappropriate exclusion criteria proposed in 13 studies [ 12 , 14 , 15 , 16 , 18 , 20 , 22 , 23 , 24 , 25 , 27 , 34 , 37 ] accounted for the high risk of bias in terms of patient selection. There was high concern that the test accuracy reported by these 13 studies could be positively affected by the fact that they removed patients with obesity, pregnancy, and other factors potentially increasing the possibility of DL.…”

Section: Resultsmentioning

confidence: 99%

“…There was high concern that the test accuracy reported by these 13 studies could be positively affected by the fact that they removed patients with obesity, pregnancy, and other factors potentially increasing the possibility of DL. The provenance of bias related to the index test was straightforward: inability to preset a diagnostic TMHT threshold [ 11 , 12 , 13 , 17 , 18 , 19 , 22 , 25 , 26 , 27 , 33 , 36 , 37 ]. Bias regarding the reference standard was basically due to the absence of blindness [ 12 , 14 , 22 , 24 , 25 , 36 , 38 , 39 ] and the un-standardized application of external laryngeal manipulation [ 11 , 12 , 16 , 18 , 19 , 20 , 22 , 26 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…In the meta-analysis of Carvalho et al [ 21 ], however, exclusion of non-English language studies may have resulted in the absence of some important studies. Most importantly, several new works assessing the performance of TMHT for prediction of DL have been published after their meta-analysis [ 22 , 23 , 24 , 25 , 26 , 27 ]. To further determine the actual performance of TMHT as a single predictor of DL, we performed this systematic review and meta-analysis including all 23 studies in the available literature.…”

Section: Introductionmentioning

confidence: 99%

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Use of the Thyromental Height Test for Prediction of Difficult Laryngoscopy: A Systematic Review and Meta-Analysis

Chen

Tian

et al. 2022

JCM

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The thyromental height test (TMHT) has been proposed as a novel single clinical test for predicting difficult laryngoscopy (DL), though consequent studies have put forward various estimates when verifying its reliability. This systematic review and meta-analysis aimed to provide a comprehensive evaluation of the predictive value of TMHT for DL. A computerized search of CNKI, CQVIP, EBSCO, PubMed, SinoMed, and Wanfang Data was conducted on 1 June 2022. Prospective cohort studies reporting diagnostic properties of TMHT in relation to Cormack and Lehane grading in patients aged more than 16 years, either sex, scheduled for surgery under general anesthesia, requiring tracheal intubation with direct laryngoscopy were included in this analysis. Data was extracted or calculated, and meta-analysis was done by the Stata MIDAS module. A total of 23 studies with 5896 patients were included in this analysis. Summary estimates of all included studies are as follows: sensitivity 74% (95% CI, 68–79%); specificity 88% (95% CI, 81–92%); diagnostic odd ratio, 20 (95% CI, 10–40); positive likelihood ratio, 5.9 (95% CI, 3.6–9.6); and negative likelihood ratio, 0.30 (95% CI, 0.23–0.39). Summary sensitivity and specificity for studies with a prespecified threshold were 82% (95% CI, 71–89%) and 94% (95% CI, 87–98%), respectively. The estimated area under curve (AUC) was 85% (95% CI, 81–88%). There was no significant threshold effect but significant heterogeneity in both sensitivity and specificity. Heterogeneity in sensitivity became insignificant after removing two outliers of sensitivity analysis. It is concluded that THMT has an overall optimal predictive value for DL in adult patients with diverse ethnicity and various risk factors, displaying better predictive values in a large patient population comparing to other recent reported bedside assessments and a previous meta-analysis. As significant heterogeneity brought by un-standardized application of external laryngeal manipulations in the included studies may have biased the results of this meta-analysis, the actual predictive value of TMHT for DL still awaits further studies with good designs and large sample sizes for better determination.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Use of the Thyromental Height Test for Prediction of Difficult Laryngoscopy: A Systematic Review and Meta-Analysis

Chen

Tian

et al. 2022

JCM

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A Prospective Study Evaluating Gender Differences of Serious Outcomes through Difficult Airway Physiological Score (DAPS) in the Emergency Department

Waheed,

Jawed,

Raheem

et al. 2024

Critical Care Research and Practice

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Introduction. Gender variation in critically ill adults after resuscitation is reported in many studies. However, this variation is not well established when evaluating the physiological instability in this population. This study aimed to prospectively evaluate the gender variation in serious outcomes by the difficult airway physiological score (DAPS) among critically ill patients requiring endotracheal intubation (ETI). Methods. This is a cohort study conducted from August 2021 to December 2022 in the emergency department of Aga Khan University. The prospective validity of the difficult airway physiological score was derived using retrospective data and includes 12 variables: sex, age, time of intubation, hypotension, respiratory distress, vomiting, shock index >0.9, pH < 7.3, fever, anticipated decline, Glasgow Coma Scale (GCS) < 15, and agitation. The serious outcomes were cardiac arrest, mortality (within 1 hour after intubation in emergency), hypotension (systolic blood pressure <90 mmHg), and oxygen desaturation (SpO2 < 92%). The difference between males and females was assessed using the chi-square test, and the association of gender and serious outcomes was explored using Cox and logistic regression analysis. ROC curve analysis and area under the curve assessed score validity separately in males and females with serious outcomes. Results. We enrolled 326 patients with a mean age of 50.3 (±17.8), with 123 (33.7%) females and 203 (62.2%) males. 198 (60.7%) patients were >45 years old, of which 136 (67%) were male and 62 (50.4%) female. Cardiac arrest was observed in 56 (17.2%), with 24 (19.5%) females and 32 (15.8%) males, p value 0.348. Hypotension after intubation was observed in 132 (40.5%) patients, 56 (45.5%) females and 76 (37.4%) males, p value 0.149. Oxygen saturation (<92%) was observed in 80 (24.5%) patients, 32 (26%) females and 48 (23.6%) males, p value 0.630. In females, the DAPS of 11 had an area under the curve of 0.863 (0.74–0.91). The sensitivity of the score was 84.8%, the specificity was 71.9%, the PPV was 77.8%, and the NPV was 80.4% with an accuracy of 78.9%. In males, the DAPS score of 14 had an area under the curve of 0.892 (0.57–0.75). The sensitivity of the score was 67%, the specificity 93.8%, the PPV 92.2%, and the NPV 72.2% with an accuracy of 79.8%. Conclusions. The Difficult Airway Physiological Score (DAPS) predicts the risk of serious outcomes after intubation with high precision and reliability with different score cutoffs between the two sexes, highlighting the gender variation of a difficult airway.

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Which test best predicts difficult endotracheal intubation? A prospective cohort study

Alp¹

2023

Ulus Travma Acil Cerrahi Derg

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Evaluation of thyromental height as a predictor of difficult laryngoscopy and difficult intubation: a cross-sectional observational study

Cited by 3 publications

References 21 publications

Use of the Thyromental Height Test for Prediction of Difficult Laryngoscopy: A Systematic Review and Meta-Analysis

Use of the Thyromental Height Test for Prediction of Difficult Laryngoscopy: A Systematic Review and Meta-Analysis

A Prospective Study Evaluating Gender Differences of Serious Outcomes through Difficult Airway Physiological Score (DAPS) in the Emergency Department

Which test best predicts difficult endotracheal intubation? A prospective cohort study

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